结核潜伏感染的研究现况概述

doi:10.3969/j.issn.2096-8493.2020.01.017

摘要/Abstract

摘要：

结核潜伏感染是目前结核病领域关注的热点。全球及我国结核潜伏感染人数众多,重点人群筛查、各国潜伏感染人群管理政策、筛查结果解读、预防性服药对象的判定、服药效果评估、疫苗研究进展等仍是值得进一步关注的问题。作者通过对以上问题进行文献复习与探讨,旨在为开展相关的研究提供学术参考。

关键词: 潜伏性结核病, 卫生政策, 预防和防护用药, 疫苗, 综述

Abstract:

Latent tuberculosis infection is a hotspot in the field of tuberculosis control. There is a large number of people with latent tuberculosis infection in the world and in China, so many issues are still worthy to be paid further attentions, such as the policies on screening of the key populations and management of the people with latent tuberculosis infection in different countries, interpretation of the screening results, identification of people who need prophylactic medication, evaluation of treatment effects and the progress of vaccine research and development, etc. The author conducted review and exploration in terms of the above issues so as to provide academic reference for the related follow-up researches.

Key words: Latent tuberculosis, Health policy, Protective agents, Vaccines, Review

姚晶, 顾凯侃, 李智红, 韩志英, 张怀庆. 结核潜伏感染的研究现况概述[J]. 结核与肺部疾病杂志, 2020, 1(1): 82-88. doi: 10.3969/j.issn.2096-8493.2020.01.017

YAO Jing, GU Kai-kan, LI Zhi-hong, HAN Zhi-ying, ZHANG Huai-qing. Research progress on latent tuberculosis infection[J]. Journal of Tuberculosis and Lung Disease, 2020, 1(1): 82-88. doi: 10.3969/j.issn.2096-8493.2020.01.017

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世界卫生组织区域	全部LTBI		近期(2年内)LTBI
世界卫生组织区域	感染率(%)	儿童(<15岁)占全部LTBI者的比率(%)	感染率(%)	耐异烟肼者占 LTBI者的比率(%)
非洲区	22.4(20.6~24.6)	13.3(11.8~14.6)	1.5(1.3~1.7)	7.4(6.4~8.7)
美洲区	11.0(7.0~20.0)	2.3(1.3~3.7)	0.2(0.1~0.2)	7.0(6.0~8.8)
东南亚区	30.8(28.3~34.8)	7.4(6.3~8.2)	1.2(0.9~1.6)	9.5(8.8~10.3)
东地中海区	16.3(13.4~20.5)	7.9(6.0~9.4)	0.7(0.5~1.0)	13.1(10.0~15.5)
西太平洋区	27.9(19.3~40.1)	2.4(1.7~3.5)	0.5(0.4~0.7)	14.7(13.9~15.6)
欧洲区	13.7(9.8~19.8)	2.0(1.3~2.7)	0.3(0.2~0.3)	29.5(23.8~45.1)
全球	23.0(20.4~26.4)	5.9(5.1~6.7)	0.8(0.7~0.9)	10.9(10.2~11.8)

第一作者	发表时间(年)	检测人群	检测方法(cut-off值)	检出率(%)(阳性例数/总例数)
全国结核病流行病学抽样调查技术指导组^[7]	2002	全人口	TST(≥6mm)	44.5(29557/66546)
刘贤政^[8]	2004	部队官兵	TST(≥5mm)	26.7(34985/131270)
He^[9]	2010	结核病防治专业人员	TST(≥10mm)	55.6(432/777)
Zhang^[10]	2013	结核病防治专业人员	T-SPOT.TB	33.6(254/755)
Zhang^[11]	2013	医务人员	T-SPOT.TB	28.7(29/101)
林涛^[12]	2011	小学生	T-SPOT.TB	3.39(16/472)
Hu^[13]	2013	儿童、青少年	T-SPOT.TB	4.702(52/1106)
郭建丽^[14]	2006	大学生	TST(≥5mm)	51.99(54719/105239)
陈莉莉^[15]	2018	大学生密切接触者	QFT-GIT	9.812(47/479)
Hu^[16]	2012	密切接触者	T-SPOT.TB	29.62(287/969)
王海英^[17]	2009	监狱羁押人员	T-SPOT.TB	27.56(86/312)
Li^[18]	2017	城市农民工	QFT-GIT	17.87(790/4422)
Gao^[19]	2015	农村人口	QFT-GIT	18.81(3955/21022)
张馨赟^[20]	2014	云南HIV感染者	T-SPOT.TB	64.3(45/70)
张馨赟^[20]	2014	上海HIV感染者	T-SPOT.TB	20.8(14/67)

治疗方案药品	成年人剂量(mg/次)		儿童剂量		用法	疗程
治疗方案药品	体质量<50kg者	体质量≥50kg者	单次剂量(mg/kg)	最大剂量(mg/次)	用法	疗程
单用异烟肼					1次/d	6~9个月
异烟肼	300	300	10	300
异烟肼、利福喷丁联合					2次/周	3个月
异烟肼	500	600	10~15	300
利福喷丁	450	600	10(>5岁)	450(>5岁)
异烟肼、利福平联合					1次/d	3个月
异烟肼	300	300	10	300
利福平	450	600	10	450
单用利福平					1次/d	4个月
利福平	450	600	10	450